Medications for Systemic Lupus Erythematosus

Many medications are used for treatment of SLE, depending on the locations and severity of your symptoms, and side effects you have from the medications. Only the most commonly used medications are listed below. A number of medications are still considered experimental or are used less frequently, but these may be required to control your disease.

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications only as recommended by your doctor, and according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

As much as possible, doctors treating SLE avoid the use of glucocorticoids (steroids) because of their severe long-term side effects. However, these drugs are very effective in relieving the symptoms of SLE and will most likely be part of your treatment program at some point.

Less dangerous medications are the mainstay of controlling the symptoms of SLE as long as they are effective. Foremost on the list are the nonsteroidal anti-inflammatory drugs (NSAIDs). They, too,
can
cause significant side effects, especially in the stomach, but none so severe as the glucocorticoids.

Antimalarial drugs are also used for their effects on the immune system.

A fourth class of drugs used in SLE is the
immune modulators. These drugs are usually used alone when steroids are not working. They may be combined with glucocorticoids when kidney disease is present to reduce the incidence of kidney failure.

Many people with SLE have skin problems, which are often treated with topical corticosteroids. Other topical treatments are also used, as well as some of the medications listed below.

Some people with SLE have antiphospholipid antibody syndrome and are at risk for blood clots. They may require long-term treatment with anticoagulants, which help keep the blood from clotting to easily.

Over the Counter Medications

Prescription Medications

Glucocorticoids

Common names include:

Prednisone

Prednisolone

For SLE, cortisone-like drugs are usually given for severe disease. They are given in short, sometimes tapering, bursts lasting 1-2 weeks. This is done to avoid the adverse effects of prolonged treatment. These doses are often quite effective in reducing inflammation, but should not be used when the inflammation is fighting off an infection. The adverse side effects increase rapidly beyond this time frame.

There are many complications associated with glucocorticoids. Even repetitive doses separated by significant intervals of time may eventually cause damage. Before taking a dose of a cortisone-like drug, be sure to ask your doctor if you have any reasons for avoiding it. Additionally, you may need to take calcium, vitamin D, osteoporosis and blood pressure medication, and to monitor your blood sugar levels while taking corticosteroids.

NSAIDs are widely used in the treatment of SLE, mostly for musculoskeletal symptoms. While they are probably safer for long-term use than corticosteroids, they can cause serious side effects. You should remain in close contact with your doctor if you are on one of these medications. They may be avoided if gastrointestinal symptoms are present.

Possible side effects of NSAIDs at high doses include:

Stomach problems, including ulcers and bleeding

Worsening of chronic conditions, such as high blood pressure,
heart failure, or kidney disease

Kidney damage

Liver inflammation

Lightheadedness

Severe allergic reaction, such as
hives, difficulty breathing, or swelling around the eyes

Increased risk of bleeding—always inform your healthcare providers that you are taking an NSAID before having any medical or dental procedures or surgeries

NSAIDs may cause an increased risk of serious cardiovascular problems, like
heart attack
and
stroke. This risk is especially important for patients with cardiovascular disease or who are have risk factors for cardiovascular disease.

Take special care with NSAIDs and aspirin if you have had peptic ulcer disease (gastric
or
duodenal ulcers, or
gastritis).

Antimalarial Drugs

Common names include:

Hydroxychloroquine sulfate

Chloroquine

Originally used to treat malaria, these drugs modify the inflammatory response in ways that benefit people with SLE. They are not used for serious, organ-threatening disease, but rather for more moderate symptoms.

Immune modulators suppress the immune system and reduce inflammation. These may be used when someone can't tolerate high doses of steroids. They may also help people who don't respond to steroids to control inflammation. Immune modulators reduce the body's ability to fight infection. It is important to monitor cuts, scrapes, or any small wounds for signs of infection. You may also be at a higher risk for bacterial or viral infections.

Possible side effects of cytotoxic agents include:

Bone marrow damage

Increased frequency of cancer

Hair loss

Ovary damage

Liver damage (azathioprine)

Bladder damage (cyclophosphamide)

Targeted B-cell Therapy

Common names include:

Belimumab

Rituximab

Targeted B-cell therapy is for who are receiving other standard therapies. The medication, given by IV, may reduce the number of abnormal B-cells thought to be responsible for tissue damage in autoimmune disease. The reduced action of infection-fighting lymphocytes increases your risk of bacterial or viral infections.

Possible side effects of targeted B-cell therapy include:

Nausea

Diarrhea

Fever

Insomnia

Depression

Migraine

Reactions during infusion, such as headache and nausea

Rash or hives at infusion site

Increased frequency of cancer

Over the Counter Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs)—lower doses

Common names include:

Aspirin

Ibuprofen

Naproxen

There are minor differences among the available agents in terms of dosing intervals, frequency of certain side effects, and other characteristics.

Possible side effects of NSAIDs at low doses include:

Stomach problems, including ulcers and bleeding

Worsening of chronic conditions, such as high blood pressure, heart failure, or kidney disease

Kidney damage

Liver inflammation

Lightheadedness

Severe allergic reaction, such as hives, difficulty breathing, or swelling around the eyes

Increased risk of bleeding—always inform your healthcare providers that you are taking an NSAID before having any medical or dental procedures or surgeries

NSAIDs may cause an increased risk of serious cardiovascular problems, like heart attack and stroke. This risk is especially important for patients with cardiovascular disease or who are have risk factors for cardiovascular disease.

Take special care with NSAIDs and aspirin if you have had peptic disease (stomach or
duodenal ulcers or
gastritis).

Anticoagulants

Common names include:

Aspirin

Heparin

Warfarin

Anticoagulants work by interfering with the clotting process. They are used in people with antiphospholipid antibody syndrome, an autoimmune disease that makes the blood clot easier. Blood clots can cause serious problems that can affect blood circulation all over the body. It also increase the risk of heart attack
and ischemic
stroke. Anticoagulant use needs to be monitored to find the right balance. Too much of an anticoagulant can cause bleeding.

Possible side effects of antigoagulants include:

Lower than normal number of platelets, which can excessively increase blood clotting time

Clinical Trials of New Drugs

There are major advances being made in SLE research. Whole new branches of medicine called molecular biology and genetic engineering are focusing on the mechanisms of immunity and inflammation. For this reason, you may want to consider participating in a clinical trial of new treatments. The government-sponsored website,
Clinical Trials,
maintains a listing of the trials that need volunteers.

Clinical trials are very tightly controlled experiments by the best researchers in the field. Every clinical trial is fully approved by several groups of knowledgeable health professionals for their safety and potential benefit. Each participant is informed of the risks and expected to cooperate completely with the treatment program. Some use medicines that are already on the market for other diseases, like the cytotoxic agents mentioned above. Others are brand new therapies that have been through at least two intense phases of testing—in the laboratory and on healthy human volunteers. Most clinical trials provide free care.

If you are interested, talk to your doctor about whether participating in a clinical trial is a good idea for you.

Special Considerations

If you are taking medications, follow these general guidelines:

Take the medication as directed. Do not change the amount or the schedule.

Ask what side effects could occur. Report them to your doctor.

Talk to your doctor before you stop taking any prescription medication.

Plan ahead for refills if you need them.

Do not share your prescription medication with anyone.

Medications can be dangerous when mixed. Talk to your doctor if you are taking more than one medication, including over-the-counter products and supplements.

When to Contact Your Doctor

Contact your doctor if:

The desired effect of your medication is not achieved

A side effect occurs

You develop new stomach symptoms

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Lupus. National Institute of Arthritis and Musculoskeletal and Skin Diseases website. Available at:
http://www.niams.nih.gov/Health%5FInfo/Lupus/default.asp. Updated February 2015. Accessed May 17, 2016.

What medications are used to treat lupus. Lupus Foundation of America website. Available at: http://www.lupus.org/answers/entry/medications-to-treat-lupus. Updated July 12, 2013. Accessed May 17, 2016.